Background: Craniocervical junction (CCJ) stenosis is a well-recognized and potentially life-threatening complication in children with achondroplasia, frequently requiring early surgical intervention. If left untreated, it can lead to devastating outcomes, including permanent neurological deficits or even death. Case Presentation: We report a rare case of a 9-year-old boy with achondroplasia and familial hemophagocytic lymphohistiocytosis who initially presented with significant CCJ stenosis. After being lost to follow-up, he was later found to have experienced spontaneous resolution of the stenosis, with no surgical intervention and no resulting neurological impairment. Conclusion: This case highlights the variability in the clinical course of CCJ stenosis in patients with achondroplasia and suggests that the need for early surgical intervention may vary among individuals. To move toward more precise and personalized care, larger studies are essential to identify predictors of spontaneous resolution and to help define clear, evidence-based management guidelines.
Background: Lumboperitoneal (LP) shunting is an effective and less invasive treatment for normal pressure hydrocephalus (NPH). However, degenerative spinal changes, such as lumbar spinal stenosis, which are common in elderly patients, can complicate lumbar puncture and increase the risk of neurological complications. We report a case in which LP shunt placement failed due to severe lumbar spinal stenosis, highlighting the need for careful preoperative assessment of the spine. Case Presentation: An 80-year-old man presented with gait disturbance and physical debilitation. Magnetic resonance imaging (MRI) revealed ventricular enlargement, and a cerebrospinal fluid tap test resulted in symptomatic improvement; therefore, LP shunting was planned. Because lumbar puncture was unsuccessful, a ventriculoperitoneal shunt was performed instead. Postoperatively, the patient developed lower extremity pain, and an MRI revealed spinal stenosis from L2 to L5. Minimally invasive lumbar decompression was subsequently performed, resulting in symptom improvement and independent ambulation. Conclusion: Although LP shunting is generally safe, spinal stenosis may obstruct cerebrospinal fluid flow and reduce its effectiveness. Preoperative MRI evaluation of the spine is essential to guide puncture strategy, anticipate technical difficulties, and minimize complications in elderly patients.
Introduction: The C1 pedicle screw fixation demonstrates superior biomechanical stability over lateral mass fixation. Nevertheless, the approach presents technical challenges, particularly in patients with anatomical constraints. In this study, the anatomical feasibility and early radiographic outcomes of freehand C1 pedicle screw placement in a Malaysian cohort were assessed, and a descriptive population-specific morphometric comparison was conducted. Methods: This study reviewed eight patients (n=16 pedicles) treated by a single senior surgeon for atlantoaxial instability and who underwent posterior cervical stabilisation using a freehand C1 pedicle screw technique (November 2022–November 2024). Preoperative CT scans, including evaluation of the vertebral artery course and sulcus arteriosus variants, were used for morphometric planning. Radiographic outcomes, including C1–C2 and C2–C7 Cobb’s angles, were measured at ≥ 3 months. Results: The eight patients (seven males; mean age, 29 years) underwent fixation with 16 C1 pedicle screws. The mean pedicle height was 5.07 ± 0.91 mm (right) and 4.65 ± 0.89 mm (left), where 18.8% of pedicles were < 4.00 mm. The mean pedicle width was 9.81 ± 0.55 mm, which implies that height is the primary anatomical constraint for screw accommodation instead of width. No neurovascular injuries, hardware failures, or cases of occipital neuralgia were observed. There was a significant improvement of the C1–C2 Cobb’s angle postoperatively (+7.13∘, p = 0.033). The C2–C7 did not undergo a significant change, although it was moderately negatively correlated to C1–C2 correction (r = -0.70, p = 0.053). Conclusion: These preliminary results demonstrated that freehand C1 pedicle screw fixation appeared anatomically feasible and potentially safe in this small group of Malaysian patients. The technique also showed satisfactory early radiographic alignment without the use of an assistive device or intraoperative navigation, supporting its applicability in settings with limited resources.
Background: Full Endoscopic Lumbar Discectomy (FELD) is one of the latest surgical techniques developed for discectomy in the lumbar spine. It is considered a truly minimally invasive procedure with results at least equal to previous techniques regarding decreasing disability and improving quality of life with an acceptable rate of complications [1, 2]. Methods: This study is a retrospective cohort study on patients who underwent a FELD procedure with patient-reported outcome measures (PROMS) and clinical findings. Of 147 patients who had a FELD procedure between 2013 and 2018, 86 answered the follow-up SweSpine PROMs, Oswestry Disability Index (ODI), and EQ5D and EQ5D VAS and were enrolled in this study. FELD patients attended a clinical examination after a mean time of 4.3 years and answered a specific questionnaire. The clinical examination included Lasegue’s test, calf muscle hypotrophy, and muscle weakness in 52 patients who attended the examination. Results: An improvement was found in ODI (from 43.5 to 14.8) and EQ-VAS (48 to 73.7). Despite the high incidence of numbness (60%) and weakness (52%), patients graded their overall satisfaction with the surgery at a mean rate of 7.55 (SD=2.8) on a 0-10 scale. 80 % of the patients would recommend FELD surgery. 83% percent of the patients reported being pain-free regarding Low Back Pain (LBP) and 87% for leg pain at the follow-up. However, a change in work assignments due to back-related problems occurred in 45% of cases. Provokable pain, defined as the ability to elicit back or leg pain through heavy lifting, static standing, running, etc, was described by 65% and 53.3% respectively. Conclusion: The main findings of this study are that patients who underwent FELD reported a high overall satisfaction rate of 7.55 on a scale of 10 and a significant improvement in PROMs despite high rates of numbness and hyperalgesia.
Study Design: Systematic review and meta-analysis. Objective: Incidental durotomies (ID) are common complications in spine surgery. The primary objective of this study was to pool and analyze the cost estimates incurred after ID in the available literature. The secondary objective was to investigate the effects of ID on likely cost drivers, including readmission rates, complications, operative time, and length of stay. Methods: Three databases, PubMed, EMBASE, and Google Scholar, were searched from inception through February 2022 for articles reporting costs associated with ID. Information on study design, demographic data, durotomy rates, and costs was extracted. The estimates were combined using random-effects models. Additional subgroup and sensitivity analyses were conducted according to a predefined protocol. Results: The initial search of all databases identified 1263 articles after duplicates were removed. The final analysis was conducted on 7 articles reporting on 17,458 ID patients and 202,960 controls. These articles evaluated the additional cost of an ID in a wide variety of spine surgical procedures. All studies, except one, were retrospective in nature and originated in the United States. IDs were significantly associated with increased cost in most studies, despite substantial heterogeneity, with estimates ranging from approximately $1,200–$16,400 USD. Overall, the major cost driver identified was increased length of stay. Secondary complications related to durotomy were not observed as a driver of cost. Conclusion: This systematic review and meta-analysis demonstrate that hospitalization costs are higher in patients suffering from IDs after spine surgery than in those without IDs. The primary cost driver in this patient population is increased length of stay.
Background Aneurysmal bone cysts (ABCs) of the spine are rare, benign, yet locally aggressive vascular lesions that predominantly affect children and young adults. Despite their benign nature, these tumors can cause neurological deficits, spinal instability, and significant intraoperative bleeding, presenting substantial management challenges. Objective To describe the clinical presentation, surgical management, and outcomes of spinal ABCs in a single-center case series. Methods A retrospective review was conducted on six patients with histologically confirmed spinal ABCs treated surgically between January 2022 and December 2023. Lesion characteristics, imaging findings, neurological status (ASIA score), surgical technique, and postoperative outcomes were analyzed. All patients underwent total tumor resection with spinal fusion. One case required a staged anterior–posterior approach due to tumor size and vertebral artery involvement; the remaining cases were treated via a posterior-only approach. Results The cohort consisted of three males and three females (mean age: 15.8 years). Lesions were located in the lumbar (50%), cervical (40%), and thoracic (10%) regions. Two patients (33%) presented with neurological deficits. All achieved full neurological recovery postoperatively (ASIA E). Preoperative embolization was performed in one patient and was associated with the lowest intraoperative blood loss. Two minor postoperative complications occurred but were managed successfully. No local tumor recurrence was observed during a minimum follow-up of 12 months. Conclusion Surgical resection with spinal stabilization is an effective treatment for spinal ABCs, offering excellent neurological outcomes and low recurrence risk. Despite its limited sample size, this series underscores the importance of individualized surgical planning, histopathological confirmation, and multidisciplinary coordination, particularly in anatomically complex or high-risk cases.
Objective Pyogenic spondylitis is becoming more common due to population aging and increases in treatment-related bacterial infection. Additionally, improved access to magnetic resonance imaging has led to the identification of more cases of pyogenic spondylitis. However, pyogenic spondylitis can also occur in relatively young people. In this study, we compared background factors and the course of treatment between younger and older patients. Methods A retrospective review of our hospital database identified 35 consecutive cases of pyogenic spondylitis treated between 2019 and 2024. After eight exclusions, 27 patients were selected. Outcomes were compared between patients younger than 65 years (n=9) and those aged 65 years or older (n=18). Results There was no significant difference in sex, site of the lesion, or presence or absence of a causative bacterium according to age group. Atopic dermatitis was significantly more common in younger patients (n=5, 56% vs. n=0, 0%, p=0.007), while diabetes mellitus or prior bacterial infection was less common (n=3, 33% vs. n=16, 83%, p=0.003). Surgery was more common in younger patients (n=5, 56% vs n=6, 33%), as was discharge to home (n=8, 89% vs. n=6, 33%, p=0.01). Conclusions Diabetes mellitus and prior bacterial infection, which are known risk factors for pyogenic spondylitis, were less common in younger patients. Furthermore, atopic dermatitis was more common in younger patients. Owing to the breakdown of the skin barrier, atopic dermatitis is known to cause not only skin-limited infections but also bacteremia-associated conditions such as infective endocarditis and pyogenic arthritis. Our finding that younger patients are more likely to be discharged home highlights the importance of appropriate treatment.
Introduction Primary intracranial tumors (PITs) rarely metastasize to the spine, and as such, the condition is poorly understood. This study aimed to provide an overview of the clinical manifestations, therapeutic trends, and prognosis of spinal drop metastases (SDM) resulting from PIT. Objective To enhance comprehension of SDM pathology, direct patient care, and encourage research participation. Methods PubMed, Medline, Scopus, Embase, CINAHL, and Cochrane databases were searched for abstracts of individuals with PIT and SDM, according to the PRISMA guidelines. Kaplan– Meier and log-rank analyses of survival curves were performed for specific subgroups. Results Of 803 abstracts, 56 articles were selected, yielding 63 subjects. The mean age was 42.95 years, and 60.31% of the participants were male. The most prevalent symptoms were cervicalgia/lumbago (74.13%) and radiculopathy (63.79%). The estimated median survival following diagnosis of PIT was 10 months, and the mean survival was 32.68 months. The predicted median survival after SDM was 3 months, and the mean survival was 3.8 months. Conclusion This study defines PIT-induced spinal metastases and calls for further research in this area. These data also provide patients and physicians with literature-based survival predictions.
Purpose Desmoid-type fibromatosis is a rare, aggressive tumor of mesenchymal origin that mimics malignancy. Though non-metastasizing, desmoid tumors exhibit local invasion and tissue destruction with high rates of recurrence, leading to severe morbidity. However, there is no standard approach for management. Hence, we present the case of a 69-year-old male with cervicothoracic desmoid-type fibromatosis and conduct a systematic review to analyze the risk factors, treatment modalities, and recurrence. Methods An extensive chart review of the patient was conducted, with special attention to contributing risk factors and follow-up examinations. A systematic search was conducted in PubMed, SCOPUS, and Embase with the terms ((vertebral) OR (spine)) AND (desmoid fibromatosis). Publications with desmoid-type fibromatosis at the cervical or cervicothoracic spine were included. A manual reference search was conducted to include all relevant publications. Results Our patient’s tumor extended from the right anterolateral C3 to the T1 level, with C5-C7 vertebral infiltration. The patient underwent a radical neck dissection, hemithyroidectomy, and hemisternotomy for tumor resection. No spinal intervention or adjuvant medical therapy was utilized. His postoperative course was complicated by right vertebral artery occlusion and transient right-sided Horner syndrome. He was discharged on postoperative day 5 with no subsequent tumor recurrence or complications. Our systematic review resulted in 21 studies with 24 patients (8 males, 16 females) at an average age of 39.98±17.23 years. The most common treatment modality was resection (n=17, 70.83%). Five patients (20.83%) had concomitant spinal decompression with or without fusion. Recurrence occurred in three patients (12.5%), at an average of 7±5.57 months after initial intervention. Conclusion In our case report and systematic review, we found that resection is the most common treatment modality for paraspinal desmoid-type fibromatosis confined to the cervical or cervicothoracic spine, with minimal rates of recurrence. Depending on tumor localization and invasion, concomitant spinal intervention may not be necessary.
Background Surgical site infections (SSIs) represent a significant source of complications following spine surgeries. In this study, iodine-impregnated plastic adhesive drapes (PAD) are explored as a means to mitigate contamination and infection risks, offering both a physical barrier and antimicrobial properties. Aim To assess the effect of iodine-impregnated plastic adhesive drapes in preventing surgical site infections after spine surgeries. Material and Methods An observational prospective study was undertaken on 90 elective spine surgery patients. Patients were divided into PAD and non-PAD groups. Baseline variables, operative parameters, and postoperative infection rates were compared. The infection was diagnosed clinically and confirmed through laboratory investigations and cultures. Results Infection occurred in two non-PAD patients (4.4%) and one PAD patient (2.2%), with no statistically significant difference. PAD patients had longer surgeries but lower infection rates. Laboratory investigations in infected patients revealed elevated ESR (Erythrocyte Sedimentation Rate), CRP (C Reactive Protein), and leukocyte counts. Conclusion The use of iodine-impregnated PADs may contribute to reduced SSI rates following spine surgeries, though the difference was not statistically significant. They can be considered adjuncts to infection prevention in high-risk spinal procedures. Larger randomized controlled trials are needed for stronger recommendations.
Background Chronic coccydynia is a debilitating condition often exacerbated by any activity that applies pressure to the coccygeal area. While diagnosis is primarily clinical, dynamic X-ray imaging has emerged as a valuable tool for identifying structural abnormalities like hypermobility or subluxation. For patients unresponsive to conservative treatments, coccygectomy (surgical removal of the coccyx) remains a definitive option. However, predicting surgical success remains challenging. Objective This narrative review synthesizes recent evidence (2015–2025) on the role of dynamic imaging in diagnosing coccydynia and its utility in predicting positive coccygectomy outcomes. Materials and Methods A review of the literature was conducted to assess studies published between 2015–2025 focusing on dynamic X-ray imaging for identifying structural abnormalities (hypermobility, subluxation) and its role in predicting surgical outcomes for coccydynia. Results Findings suggest that patients with coccygeal instability, retroversion, or subluxation on dynamic imaging tend to experience better postoperative pain relief and quality-oflife improvements compared to those with normal or immobile coccyx. For instance, hypermobility (>25∘ flexion) or traumatic etiology may correlate with favorable surgical results, while idiopathic cases or normal anatomy often yield poorer outcomes. Despite these insights, limitations like small sample sizes, inconsistent imaging protocols, and lack of long-term data highlight the need for standardized guidelines. Conclusion Clinical observations, along with our team’s decade-long experience, reinforce that dynamic imaging can refine patient selection by distinguishing those most likely to benefit from surgery. Future research should prioritize large, prospective studies with uniform imaging criteria and integrate psychosocial factors to optimize predictive accuracy. By addressing these gaps, dynamic imaging could evolve into a cornerstone of precision medicine for coccydynia, ensuring tailored treatments and improved surgical outcomes.
Introduction Transforaminal lumbar interbody fusion (TLIF) is a widely used surgical technique for treating several spinal pathologies. While various bone graft materials (autograft, allograft, demineralized bone matrix) and cage materials (PEEK, titanium) are utilized in TLIF surgeries, there is a need to compare their effectiveness and safety to guide optimal material selection. Aim This study aims to compare the efficacy and safety of different bone graft materials used in TLIF surgeries by analyzing fusion rates, clinical outcomes, and complication rates across various studies. Methods A systematic search was conducted on PubMed and Google Scholar for studies related to TLIF and bone graft materials up to December 2023. Inclusion criteria were randomized controlled trials (RCTs) and prospective and retrospective cohort studies that reported quantitative outcomes like fusion rates and clinical improvement with a minimum post-operative follow-up of one year. Data from 11 studies were extracted and analyzed. Results This review included 11 studies with a total of 986 observations and 878 fusion events. The overall fusion rate was 87% (95% CI: 79%-94%), with significant heterogeneity among studies (I² = 92%). Autografts showed the highest fusion rate at 94% (95% CI: 90%-98%), with no heterogeneity (I² = 0%). Polyetheretherketone (PEEK) cages demonstrated a fusion rate of 90% (95% CI: 83%-97%), with moderate heterogeneity (I² = 80.6%). Allografts had a fusion rate of 76% (95% CI: 54%-98%), with high heterogeneity (I² = 86.7%). Titanium cages had a fusion rate of 87% (95% CI: 75%-99%), with moderate heterogeneity (I² = 79.9%). Visual Analogue Scale (VAS) scores for back pain in Heinz et al. (2017) decreased from 7.47 to 3.08 in Group A and from 6.78 to 3.17 in Group B at 12 months post-op. The overall Oswestry Disability Index (ODI) scores improved from pre-operative values of 53.0 to post-operative values of 22.3 in Li et al. (2020). Conclusions Autografts remain the gold standard for TLIF due to their high fusion rates, but synthetic materials like PEEK and titanium are effective alternatives with comparable fusion success and fewer complications related to graft harvesting. Continued research and innovation in developing new graft materials could enhance treatment outcomes in spinal surgery.
Background Cerebrospinal fluid (CSF) leak is a known complication of spine surgery, and an effective protocol for prevention, recognition, and treatment of postoperative CSF leak is essential to avoid a cascade of associated adverse outcomes, such as durocutaneous fistula, wound infection, and intracranial hemorrhage. We aim to identify the incidence of CSF leak post spinal surgeries and to obtain the factors that could predict the risks of having a CSF leak following spine surgeries. Methods This study was conducted as a retrospective cohort study on patients who had CSF leaks post spinal surgery in King Abdul-Aziz Medical City, Jeddah, from June 2016 to January 2024. Results The occurrence of cerebrospinal fluid (CSF) leak post-surgery was relatively low (2.6%), and more than 97% of the participants studied had no CSF leak. There is a statistically insignificant relation with age, gender, DM, BMI, hypertension, malignancy, and cardiovascular diseases. Still, there is a statistically significant relation with the attempt to watertight closure, and type of surgery (P value ≤ 0.05). Conclusion Postoperative CSF leak following spinal surgery is associated with morbidity and can lead to re-operation and infection. The incidence of CSF leaks among our study participants was about 2.6%, which is relatively low. Identifying predictors for CSF leaks can assist in counseling patients concerning surgical risk and expected postoperative recovery.
Study Design Prospective observational study. Objective This study aimed to correlate the degree of paraspinal muscle fatty infiltration with the severity of lumbar canal stenosis, the demographic characteristics of the patient, the radiological parameters, and clinical scores. Material and Methodology This is a single-centre observational study in patients with secondary degenerative lumbar canal stenosis in patients older than 35 with radiological features matching the clinical symptoms. The demographic characteristics, fatty muscle infiltration (FMI) grade of multifidus and erector spinae muscles, lumbar canal stenosis (LCS) grade, neurological status, visual analogue scale (VAS) score, oswestry disability index (ODI) score, and endplate modic changes were recorded. The statistical analysis was done using SPSS v.25. For the comparison of categorical variables between groups, a chi-square test was used. A p-value <0.05 was considered to be statistically significant. Results The mean age of the study participants was 62.2 ±10.9 years. Of the 150 patients, 60.7% were women. The mean BMI of the patients was 27.8 ± 2.8 kg/m2. 121(80.7%) patients presented with low back pain at their first visit. 36.7% of the patients presented with claudication symptoms at their first visit. It was observed that 3.3% of the patients presented with cauda equina syndrome (CES). The mean duration of symptoms was 20.9 ± 16.3 months. The mean VAS score at the presentation was 5.9 ± 1.3. The mean ODI score at the first visit was 27.7 ± 6.1. Fatty muscle infiltration of the multifidus but not the erector spinae is associated with higher pain and ODI scores. The grade of FMI does not significantly correlate with the grade of LCS. Age significantly affects degenerative paraspinal muscle changes independent of the pathology. Other factors like BMI, gender, presence or absence of modic changes do not significantly affect the severity of stenosis, degree of paraspinal muscle fatty infiltration, and the pain and disability scores of the patients. Conclusion The study revealed that the grade of FMI does not significantly correlate with the grade of degenerative lumbar canal stenosis. Age significantly affects degenerative paraspinal muscle changes independent of the pathology.
Introduction Sagittal imbalance significantly impacts outcomes in adult degenerative spine conditions. Lumbar lordosis (LL) restoration is essential for spinopelvic alignment. Posterior or posterolateral fusions using hypo-lordotic implants can exacerbate spinopelvic imbalance by increasing the already existing hypo-lordosis. This study examines the impact of L5-S1 anterior lumbar interbody fusion (ALIF) on sagittal alignment in patients with adjacent segment disease following prior posterior or posterolateral lumbar fusions. Methods This retrospective study included 17 patients with a history of lumbar fusions, treated with L5-S1 ALIF at AZ Delta Hospital between 2019 and 2024. Pre-operative and post-operative radiographs were assessed for (proximal and distal) LL and sagittal balance parameters. Changes in alignment were analyzed with paired samples t-tests after verification of normal distribution. Results Pre-operative LL averaged at 43.7∘ (95% CI [36.1–51.3]) and improved significantly to 50.1∘ (95% CI [43.5–56.7] p < 0.05) post-operatively, primarily due to an increase of distal LL from 25.5∘ to 35.2∘ (p < 0.001). The pelvic incidence–lumbar lordosis (PI-LL) mismatch decreased significantly from 39.0∘ to 18.9∘ (p < 0.05), while the sagittal vertical axis (SVA) reduced non-significantly from 97.3 mm to 86.7 mm. Discussion L5-S1 ALIF has the potential to effectively restore LL and reduce PI-LL mismatch in patients with degenerative spine conditions and a history of lumbar hypo-lordotic fusions. Study limitations include a small sample size, missing full-spine radiographic data in a subset of patients and lack of long-term follow-up. These limitations underscore the need for validation through larger, prospective studies with standardized imaging and clinical follow-up. Conclusion This study highlights the efficacy of L5-S1 ALIF in restoring lumbar curvature, reducing PI-LL mismatch and improving sagittal alignment in patients with a history of lumbar fusions. Despite the challenges of fixed hypo-lordosis resulting from previous hypo-lordotic lumbar fusions, our findings demonstrate that L5-S1 ALIF can significantly increase LL and reduce forward trunk inclination. Future studies involving larger patient cohorts and extended follow-up are warranted to validate these findings and evaluate their long-term clinical implications.
Purpose Even though plate and screw designs in anterior cervical discectomy and fusion (ACDF) have evolved to improve fusion stability and enhance patient outcomes, some argue that pre-tapping remained the best option. The purpose of this study is to evaluate the outcomes and complications of self-drilling, self-tapping screws and evaluate their efficacy in maintaining instrumentation position in plated ACDFs. Methods In this retrospective case series, patients who underwent ACDF with plating and selfdrilling, self-tapping screws from February 2021 to May 2023 were consecutively included. Demographic, radiographic, intraoperative, and postoperative data were collected. Odds ratios (ORs) were also utilized to determine factors associated with abnormal C2-C7 Cobb angles and C2-C7 sagittal vertical axes (SVAs) postoperatively. Results A total of 50 patients (26M, 24F, mean age: 56.7 ± 10.4) were included. At the final postoperative radiographic follow-up (251.1 ± 226.5 days), the C2-C7 Cobb angle increased by 21.03%, with the C2-C7 SVA increasing by 3.25%. OR assessment found an association with the American Society of Anesthesiologists (ASA) physical status classification score of ≥ 3 and abnormal postoperative C2-C7 SVA (5.667, 95% CI: 1.067 to 30.086, p=0.042). Longer operative times (≥91.5 minutes) were less likely to be associated with abnormal postoperative C2-C7 Cobb angles when compared to shorter operative times (0.175, 95% CI: 0.032 to 0.952, p=0.044). No fixation system complications or evidence of radiographic or clinical pseudoarthrosis were noted. Conclusion Patients undergoing ACDF with self-drilling, self-tapping screws had excellent postoperative outcomes and no evidence of instrumentation complications, including pseudoarthrosis. This case series demonstrates the safety of ACDF with this screw design. However, future studies should include a larger cohort of patients to provide more accurate guidelines and recommendations.
The article presents a case study on the surgical correction of a severe cervical kyphotic deformity that developed as a post-radiotherapy complication in a pediatric patient. This deformity was treated through a two-stage procedure involving gradual halo traction followed by combined anterior and posterior cervical fusion. The patient, a 15-year-old girl with a history of radiation therapy for a posterior fossa tumor, exhibited significant deformities that compromised her quality of life. Initial halo traction improved the curvature by approximately 60%, after which a 180-degree cervical reconstruction was performed to achieve near-complete correction. The first stage of the surgery involved posterior decompression and occipito-cervical fixation, while the second stage addressed anterior structural support through discectomy and fusion. The multidisciplinary approach led to a stable cervical alignment with notable functional recovery over an 18-month follow-up, including improvements in oral feeding, gaze stability, and motor function. The article discusses the complexities of managing radiation-induced spinal deformities in pediatric patients, emphasizing the importance of early diagnosis and a comprehensive surgical approach to optimize long-term outcomes
Introduction Khan Kinetic Treatment (KKT) utilizes high-frequency, small-amplitude sinusoidal waves to activate neuromuscular structures to treat neck and back pain. It integrates biomechanics, physical therapy, and neurophysiology. Despite its global use, KKT is not included in clinical guidelines for neck and back pain due to limited data on its safety and efficacy. This study aims to evaluate the available literature on KKT’s current practice in spinal pain management. Methods A systematic literature search of PubMed and Google Scholar identified articles on KKT for cervical and lumbar pain using specific keywords. Eligibility criteria included English-language articles without publication date restrictions, patients over 18 years of age undergoing KKT for neck or lower back pain, any outcome measure, and no restrictions on study design or publication date, with the latest date being June 2024. Results The search yielded 219 articles; 5 studies met the inclusion criteria and quality assessment. The studies included three Randomized controlled trials (RCTs) and two case reports. Sample sizes ranged from 1 to 49 participants, focusing on neck and lower back pain. The RCTs were rated as Level 2 evidence, while other studies were rated as lower evidence. A high risk of bias was observed in the included trials, and significant heterogeneity in design and outcomes precluded meta-analysis. Conclusion Current evidence on KKT’s efficacy for spinal pain is sparse and inconsistent. While some studies suggest benefits in pain reduction and functional improvement, methodological limitations and small sample sizes undermine generalizability. Further, well-designed studies are needed to evaluate KKT’s efficacy, safety, and costeffectiveness.
Introduction The lumbosacral transitional vertebra (LSTV) theoretically offloads the inferior intervertebral disc and may reciprocally load up the relevant adjacent disc. In this study, we evaluate the influence of LSTV on clinical outcomes of adjacent discectomy in young adults with lumbar disc herniation (LDH). Methods This retrospective study included two groups. Group A consisted of 32 LDH patients with LSTV (16 males and 16 females), and Group B included 167 LDH patients without LSTV (89 males and 78 females). All patients underwent single-level discectomy at the adjacent level to LSTV and were followed for a minimum of 24 months post-surgery. The diagnosis of LSTV was based on radiography and computed tomography (CT) scanning performed preoperatively for all patients. Outcome measurements were performed with pain assessment at each follow-up visit using a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and recurrence rate. Results At 24 months after discectomy, the mean VAS scores for low back pain (LBP) and leg pain and ODI scores showed no significant differences between the two groups. Recurrence occurred in 25 patients (15%) in Group A and in 4 patients (12.5%) in Group B. Conclusions In the patients with LDH who underwent microlumbar discectomy, after a mean follow-up period of 48.4 ± 13.7 months, we could not find any significant difference in terms of pain, disability, patient satisfaction, or recurrence rate between the group with versus without LSTV.
Introduction Spinal arachnoid cysts are commonly encountered throughout all age groups and are often managed observantly, but a minority cause symptoms requiring intervention. These cysts can be caused by congenital malformations, trauma, inflammation, or even occur spontaneously. A vast majority of arachnoid cysts in the spine are extradural, and about 10% are intradural. One type of intradural cyst occurs between two leaflets of the dura, described as an interdural cyst. Case Report This case report describes a 47-year-old female with an interdural arachnoid cyst spanning the thoracolumbar region (T11-L3). Initially, the patient was asymptomatic but later presented with progressive neurologic symptoms, including intermittent back pressure, heaviness in her legs, paresthesia, urinary hesitancy, and decreased sensation in the perineal area. Surgical intervention via direct lumbar laminectomy was performed from the bottom of T11 to the top of L3, revealing an interdural cyst without communication to the subarachnoid space. Thus, surgical fenestration was performed to establish a pathway between the cyst and the subarachnoid space to alleviate symptoms and prevent recurrence. Discussion The absence of communication between the cyst and the subarachnoid space suggests alternative mechanisms, such as a ball valve mechanism, contributing to cyst expansion. A comprehensive review of existing literature on interdural cysts underscores the necessity for revised classification systems, considering both their fluid content and communication with the subarachnoid space. Conclusions The proposed classification of interdural cysts based on CSF analysis and connection to the subarachnoid space may guide operative management and provide more information on the etiology. This classification system could refine outcome data in the operative management of interdural spinal cysts.
